Objective:To evaluate the effect of electroacupuncture on P2X4R-p38 mitogen-activated protein kinase (p38 MAPK)-brain-derived neurotrophic factor (BDNF) signaling pathway in trigeminal ganglion of rats with trigeminal neuralgia.Methods:Thirty-six clean-grade healthy adult male Sprague-Dawley rats, weighing 190-230 g, aged 2-3 months, were divided into 3 groups ( n=12 each) using a random number table method: sham operation group (S group), trigeminal neuralgia group (TN group), and electroacupuncture group (E group). The model was developed by chronic constriction of the infraorbital nerve in anesthetized animals. The infraorbital nerve was only exposed without ligation in group S. Rats received electroacupuncture stimulation at the Baihui and Xiaguan acupoints on the affected side for 20 min after developing the model, with a frequency of 80 Hz, twice a day, for 14 consecutive days in E group. Facial mechanical pain threshold (FMT) was measured at 1 day before developing the model and 3, 7, 14, 21 and 28 days after developing the model. The rats were sacrificed after the last behavioral testing, and the trigeminal ganglia were taken for examination of histopathological changes of trigeminal ganglion (by HE staining) and for determination of the expression of P2X4R, p38 MAPK, phosphorylated p38 MAPK (p-p38 MAPK) and BDNF (by Western blot) and contents of tumor necrosis factor-alpha (TNF-α), interleukin-1beta (IL-1β) and IL-6 (by enzyme-linked immunosorbent assay). Results:Compared with group S, the FMT was significantly decreased at each time point after developing the model, the expression of P2X4R, p-p38 MAPK and BDNF in trigeminal ganglion was up-regulated, and the contents of TNF-α, IL-1β and IL-6 were increased ( P<0.05), the pathological changes of the trigeminal ganglion were obvious in group TN. Compared with group TN, the FMT was significantly increased at each time point after developing the model, and the expression of P2X4R, p-p38 MAPK and BDNF in trigeminal ganglion was down-regulated, and the contents of TNF-α, IL-1β and IL-6 were decreased ( P<0.05), and the pathological changes of the trigeminal ganglion were significantly attenuated in group E. Conclusions:The mechanism by which electroacupuncture alleviates trigeminal neuralgia may be related to inhibiting the activity of P2X4R-p38MAPK-BDNF signaling pathway and reducing neuroinflammation in rats.

Osteoporotic thoracolumbar fracture in the elderly will seriously reduce their quality of life and life expectancy. For osteoporotic thoracolumbar fracture in the elderly, spinal reconstruction is necessary, which should comprehensively consider factors such as the physical condition, fracture type, clinical characteristics and osteoporosis degree. While there lacks relevant clinical norms or guidelines on selection of spinal reconstruction strategies. In order to standardize the concept of spinal reconstruction for osteoporotic thoracolumbar fracture in the elderly, based on the principles of scientificity, practicality and progressiveness, the authors formulated the Clinical guideline for spinal reconstruction of osteoporotic thoracolumbar fracture in elderly patients ( version 2022), in which suggestions based on evidence of evidence-based medicine were put forward upon 10 important issues related to the fracture classification, non-operative treatment strategies and surgical treatment strategies in spinal reconstruction after osteoporosis thoracolumbar fracture in the elderly, hoping to provide a reference for clinical treatment.

Objective:To observe whether parathyroid hormone (PTH) 1-34 can block the negative osteogenesis of advanced glycation end products (AGEs) on bone marrow mesenchymal stem cells (BMSCs) in rats and its possible signaling pathways.Methods:BMSCs from 4-week-old SD rats were isolated and cultured with whole bone marrow method. The osteogenic induction fluid, bovine serum albumin(BSA), AGEs, AGEs combined with PTH1-34 were pretreated respectively. After 7 days, realtime fluorescence quantitative PCR (RT-PCR) was used to measure alkaline phosphatase (ALP), collagen-Ⅰ (COL-Ⅰ) mRNA expression level, and the expressions of β-catenin, osterix (OSX), runt-related transcription factor 2 (RUNX2), and receptor for advanced glycation end products protein were examined by Western blotting. Alizarin red staining mineralized nodules and quantitative detection were performed on 21 days. After the addition of Wnt pathway specific blocker Dickkopf-1 (DKK1) (1 μg/ml) to 10 -8 mmol/L of PTH1-34, the protein expression levels of β-catenin, OSX, and RUNX2 were detected again by Western blotting. Results:AGEs significantly inhibited the expression of ALP, COL-Ⅰ mRNA, β-catenin, OSX, and RUNX2 proteins ( P<0.05). PTH1-34 inhibited AGEs after pretreatment, the expression of ALP, COL-Ⅰ mRNA, and β-catenin, OSX, RUNX2 protein were higher than those of AGEs group ( P<0.05). The mineralized nodules stained with alizarin red showed reddish brown and increased OD value was detected quantitatively in PTH1-34 group, which was higher than that of AGEs group ( P<0.05). DKK1(1 μg/ml) reduced the expression of β-catenin, OSX proteins as compared with the BSA group ( P<0.05). Conclusion:PTH1-34 blocks AGEs′ negative osteogenesis to BMSCs through Wnt/β-catenin signaling pathway.

Objective To study the roles of ethyl pyruvate ( EP ) in spinal cord edema after spinal cord injury ( SCI ) and in spinal cord astrocytic swelling after oxygen-glucose deprivation and reoxygenation ( OGD/R) in vitro in rats. Methods After SCI models were established in adult Sprague-Dawley ( SD ) rats, an intraperitoneal injection of EP was conducted to inhibit high mobility group box-1 ( HMGB1 ). Effects of EP on spinal cord edema, HMGB1 expression and astrocyte activation ( glial fibrillary acidic protein ( GFAP ) expression) in SCI rats were analyzed. Spinal cord astrocytes were cultured in post-natal SD rats and incubated under OGD/R procedure. Effects of EP on cell swelling, expression of HMGB1, aquaporin-4 ( AQP4 ) and toll-like receptor 4 ( TLR4 ) , and nuclear expression of nuclear factor-kappa B ( NF-κB ) in spinal cord astrocytes were observed. Results The water content in the spinal cord was increased significantly more at 1 d after SCI than at 12 h and 3 d ( P ＜0.05 ). Intraperitoneal injection of EP at 50 mg/kg reduced spinal cord water content, HMGB1 expression and astrocyte activation ( GFAP expression ) in SCI rats signif-icantly more than that at 25 mg/kg or 100 mg/kg ( P ＜0.05 ). The volume of spinal cord astrocytes cultured in vitro after OGD 6 h/R 24 h was significantly greater than that after OGD 6 h/R 6 h or OGD 6 h/R 12 h ( P ＜0.05 ). EP at 12 μmol/L reduced cell swelling, decreased expression of HMGB1, AQP4 and TLR4, and downgraded nuclear expression of NF-κB in spinal cord astrocytes after OGD/R significantly more than EP at 6 μmol/L( P ＜0.05). Conclusion EP may reduce early spinal cord edema after SCI, attenuate spinal cord astrocyte swelling and decrease AQP4 expression after OGD/R in vitro by inhibiting HMGB1 in rats.

BACKGROUND:Spinal internal fixation is widely used in the treatment of lumbar spondylolisthesis, with the purpose of lumbar fusion, reconstruction of lumbar sagittal sequences, relieving spinal cord or nerve root compression. OBJECTIVE:To review the biocompatibility of lumbar spinal implants applied in the treatment of degenerative lumbar spondylolisthesis. METHODS:A computer-based retrieval of PubMed and CNKI was performed for relevant articles published from January 2000 to January 2015. The keywords were biocompatibility, degenerative lumbar spondylolisthesis, implant in English and Chinese, respectively, which appeared in the title and abstract. RESULTS AND CONCLUSION:Lumbar spinal implants commonly used include pedicle screws and interbody fusion cages. The fusion cages are mainly classified as biological fusion cage, metal fusion cage, composite fusion cage and absorbable fusion cage. Internal fixation implants made of different materials have different biocompatibilities, but also develop different stabilities. With the development of bionics, 3D printing technology, biomechanics and materials science, lumbar spinal implants wil have better biocompatibility, bone substitute capability and biomechanical properties.

Objective To respectively investigate the impact of perioperative use of antibiotics on incision healing of simple upper limb closed fracture.Methods The study enrolled 124 patients with simple upper limb closed fracture treated from October 2012 to June 2013,including fracture of humerus (surgical neck,shaft,and supracondyla),fracture of forearm (ulna,olecranon,and radius)and fracture of metacarpus.The patients were allocated to non-antibiotic group (n =73) and antibiotictreated group (n =51) according to the random number table.Between-group analysis was made on body temperature,peripheral white blood cell count,C-reactive protein level,drainage fluid culture and incision healing.Results Sex,age,disease entity and operation time were similar between the two groups (P ＞ 0.05).Non-antibiotic and antibiotic-treated groups showed no significant differences in body temperature [preoperation:(36.50 ± 0.27) ℃ vs (36.70 ± 0.39) ℃ ; postoperation:(37.64 ± 0.37) ℃vs (37.41 ±0.41)℃],peripheral white blood cell count [preoperation:(6.1 ±1.0) × 109 mol/L vs (6.5 ±0.8) × 109 mol/L; postoperation:(12.1 ±0.7) × 109 mol/L vs (11.3 ±0.6) × 109mol/L] and C-reactive protein level [preoperation:(7.2 ±0.9)mg/L vs (6.7 ±0.7)mg/L; postoperation:(12.0 ± 1.3) mg/L vs (13.4 ±0.9)mg/L] (P ＞0.05).Incisional infection occurred in 1 case (1％) in non-antibiotic group,but none in antibiotic-treated group (P ＞ 0.05).Conclusions For simple upper limb closed fracture,perioperative use of antibiotic has advantages of slight trauma,short operation time and few bleeding.Likewise,satisfactory bone healing is achieved in the absence of antibiotics during perioperative period.

Objective To investigate the clinical features, operation procedures and clinical outcomes of cervical spondy-lotic myelopathy with different imageological characteristics. Methods Two hundred and twenty one cervical myelopathy with different imageological characteristics patients between November 2011 and October 2013 were involved in this retrospective study. Patients were distributed into three groups, namely mild group (A), moderate group (B) and severe group(C), based on severi-ty of complexity by imageological variables (severity of cervical spine degeneration, the number of spinal cord compression, severi-ty of spinal cord compression and difficulty in operation). Preoperative and postoperative Japanese Orthopaedic Association (JOA) score and mean recovery rate were collected to evaluate the postoperative clinical effects. Demographic data and imageological characteristics were recorded;Univariate analysis or analysis of variance was conducted to analyze the correlation between post-operative JOA recovery rate with gender, age, course of disease, severity of spinal cord compression, the number of segment with spinal cord compression, severity of disc degeneration, MRI T2 increased signal intensity, cervical instability, cervical kyphosis, developmental cervical spinal stenosis and ossification of posterior longitudinal ligament. Results There was no significant differ-ence in gender between three groups. There was significant difference in age, preoperative JOA score and improvement rate be-tween group A and group B (C). All patients received decompression and reconstruction by anterior or posterior approach. The ra-tio of anterior approach in group A, B and C was 91.1%(72/79), 79.8%(71/89), 35.8%(18/53). The last follow-up JOA recovery rate of group A, B and C was 75.4%±6.4%、67.7%±8.7%、62.8%±10.4%. The last follow-up JOA recovery rate was correlated with duration of disease, the number of spinal cord compression and severity of spinal cord compression. Age, duration of course, preop-erative JOA score, degree of cord compression, the number of segment with cord compression, degree of disc degeneration, MRI T 2 increased signal intensity, cervical instability, cervical kyphosis, developmental cervical spinal stenosis and OPLL. Conclusion Patients suffering from cervical myelopathy with different imageological have good prognosis by appropriate operation procedure.

ObjectiveTo discuss the selection of surgical approach,operative methods,and stability of reconstitution of affection of cervicothoracic junction.MethodsFrom January 2001 to February 2009,86cases with affection of cervicothoracic junction were treated surgically.The mean age of patients at the time of surgery was 43.1 years (range,17-70).Fifty-seven patients were treated with anterior approach (fixation with autologous bone grafts was done in 38 patients,Cage fixation in 5,titanium mesh in 14),21 with posterior approach(the fixation of lateral mass screw combined with pedicle screw was used in 12 patients,fixation with pedicle screw in 9),and 8 with anterior combined posterior approach.The neurological function of 53 cases of injury of cervicothoracic junction was assessed by American Spinal Injury Association (ASIA) criteria,and the rest was assessed by Japanese Orthopaedic Association(JOA) criteria; bone arthrodesis and restoring lordosis of cervical spine were assessed by Bohlman radiographic criteria.ResultsSixty-nine cases were followed up for an average of 12.4 months(range,3-45).ASIA score increased from 1.8 preoperatively to 2.3 postoperatively,and JOA score increased from 10.3 preoperatively to 12.8 postoperatively.Bone fusion reached in all patients,and lordosis of the cervical spine of 62 cases was restored.One case with respiratory dysfunction,1 case with cerebrospinal fluid leakage,2 cases with hoarseness,and 1 case with loose lateral mass screw were found after the surgery.ConclusionThe advantages of surgical reconstitution of the cervicothoracic junction included promoting recovery of neurological function,restoring the alignment and lordosis of the cervical spine,decreasing the rate of complication,which were dependent on the suitable surgical indications,surgical approach,and way of surgical reconstitution.The selection of reconstituted methods depends on disease,lesion site,type and degree of injury,experience of doctor,decompression and spinal stabilization synthetically.

Objective To explore the indications of cervical artificial disc replacement (ADR) based on radiographic evaluation and different anterior decompression methods. Methods From January 2008 to July 2009, 175 patients with cervical spondylosis or disc herniation who underwent anterior decompression were involved in this study. Patients were distributed to different operative groups based on the preoperative radiographic evaluation. One hundred and forty-five cases were treated with fusion operation, and the others received ADR. Operative methods were as follows: 1) Anterior cervical discectomy and fusion (ACDF); 2)Anterior cervical discectomy and subtotal vertebrectomy; 3) Anterior subtotal vertebreetomy and fusion; 4)ProDisc-C ADR. The patients with single-level of cervical spondylotic myelopathy were divided into ACDF and ADR groups according to different operative methods. Clinical outcomes of two groups were evaluated by Japanese Orthopaedic Association (JOA) score. The range of motion (ROM) of the segment was recorded in ADR group at the 1st month, 3rd month, 6th month and 12th month postoperatively. Results The indication of ADR was cervical spondylosis with slight disc calcification or small vertebral posterior osteophytes. Under this condition, decompression could be obtained thorough intervertebral space and ADR be implanted. If cervical spondylosis was associated with vertebral posterior huge osteophytes, serious intervertebral narrow or fusion, serious disc calcification ,ossification of the posterior longitudinal ligament and extensive cervical spinal stenosis, subtotal vertebrectomy was necessary. The mean improvement rates of ACDF and ADR were 66.05% and 67.13%. There was no difference between two groups (P ＞ 0.05). No difference of ROM was found before and after surgery in ADR group (P ＞0.05). Conclusion Only decompression can be achieved thorough through the intervertebral space, and ADR is suitable for cervical spondylosis. ACDF and ADR have similar outcomes in treatment of single-level of cervical spondylotic myelopathy. But ADR has the advantage of maintaining ROM of the operative segment.

Objective Aspirin has been used extensively in primary and secondary prevention of cardiovascular disease,particularly for subjects at high risk such as metabolic syndrome.However,the responsiveness to aspirin treatment may vary among individuals.The present study was conducted to investigate the profile and prevalence of aspirin resistance in patients with metabolic syndrome.Methods In 221 consecutive patients,platelet aggregation induced by arachidonic acid (0.5mg/ml) was assessed after 10 days of aspirin treatment (200mg/d).Aspirin resistance was defined as mean optical platelet aggregation =20%.Results Aspirin resistance occurred in 39 patients (17.6%).Serum fibrinogen level was higher in patients with than in those without aspirin resistance (2.6_+0.4g/l vs 2.4±0.4g/L,P=0.017).The 2 groups,aspirin resistance group and no aspirin resistance group,did not differ significantly,with regard to gender,age,body mass index,waist-hip ratio,blood pressure level,serum cholesterol level and history of myocardial or cerebral infarction.Multivariate logistic regression analysis revealed that only serum fibrinogen level entered the model (odds ratio 2.973,p=0.023).Subgroup analysis further showed that aspirin resistance occurred more in male patients with myocardial infarction (50% vs14.5%,P=0.02) and in female patients with diastolic blood pressure=85mmHg (34% vs 15.5%,P=0.043).But after multifactor logistic regression,in women blood pressure=85mmHg was not a predictor any more.Conclusions In patients with metabolic syndrome,aspirin resistance is not uncommon,especially for men with history of myocardial infarction.Patients with aspirin resistance have an increased serum fibrinogen level.(J Geriatr Cardio12008;5:7-10)